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This paper presents considerable detail about a particular patient, as well as the relevant literature and clinical data that are useful in the further understanding
of fugue states. Fugues are manifestations of altered states of consciousness stemming from a variety of physical and/or psychological causes. They represent intense underlying needs to escape from threatening and painful realities. Previously, Fisher has classified fugues into types of increasing severity and separation from more conscious states of awareness and identity. These are really to be seen as a continuum, rather than as discrete entities.
The work with the patient under study suggests that his sleep-talking episodes are nocturnal equivalents of his daytime fugue episodes; they are similar in mental content and differ only in the factor of motility. The data indicate that the dream, the fugue, and some sleep talk are psychological correlates related to the REMP organismic state. This relationship is viewed as having both a physiological and a psychological basis. A similar continuity is postulated between the three organismic states of wakefulness, NREM, and REM sleep. In this particular patient the relationship of these states to his underlying conflicts is made quite clear, but the particular choice of symptom, as is so often true in psychoanalysis, remains somewhat inexplicable. The introduction of the physiological correlates may prove quite useful along these lines.